Reimbursement

Michael Beebe

Executive Vice President

Our clients are innovative. They drive change through new clinical pathways or interventions. We help them obtain codes, secure reimbursement, and gain or enhance coverage.”

Solution Spotlight

We bring a multidisciplinary, data-enabled, current and future landscape-driven approach to coverage and payment, including coding and pricing of products and services.

By executing integrated access and reimbursement policy planning with client advocacy and allied development, we help clients advance, adapt, mitigate risk, or seek new opportunities.

  • We fuel stakeholder considerations with expert advice from professionals that served inside AMA CPT, CMS, HHS, commercial payers, Medicaid, HTA, and industry.
  • We have written and reviewed hundreds of code applications, local and national or commercial coverage decisions, and fee schedule requests.
  • We advise on when to apply for a new or revised code, how the RUC or CMS may value the code and assign a unit of measure, how to navigate the NTAP and DRG processes, when a new ICD-10 code is warranted, and how to request a new code.
We’re known for our expertise in:

Coding is a fundamental language of medicine that changes endlessly. Maximizing access requires expertise in the complex interaction of precedent, process, politics, and policy and the ability to develop the right value story for Medicare, Medicaid, and private payers, who need a compelling story of how you deliver value to patients. Our work may include direct engagement with the FDA, CMS, and other payers or assistance improving clinical outcomes to demonstrate evidence of utility.

Bespoke
Solutions

  • ADVI SAVEs data-informed NTAP financial modeling for breakthrough medical technologies and cell and gene therapies
  • HCPCS applications, ICD-10, and NTAP and DRG Applications
  • Med tech and diagnostic pricing through the AMA RUC and CMS
  • Cross-payer Reimbursement Strategy and Landscape Analysis
  • NTAP and IPPS Modeling, Application, and Advocacy
  • Telemedicine and Remote Monitoring Strategy and Advocacy
Our Experts

Complementary
Products

Cross-Payer Reimbursement Landscapes

We provide a thorough scan of the current and expected coverage and reimbursement landscape. From commercial to Medicare and Medicaid payer types, we incorporate the knowledge of how each defines a compelling value proposition into the language and currency of the particular payer.

CPT and HCPCS Code Applications

ADVI’s consultants have written and reviewed hundreds of code applications. We advise on when to apply for a new or revised code, what the RUC or CMS may value the code at, how to navigate the NTAP and DRG processes, and when a new ICD-10 code is warranted, while helping successfully navigate the complex application and CMS and AMA advocacy processes.

CMS and HHS Strategy and Advocacy

Our team has near 50 years of combined experience working directly for or with CMS, HHS, or state government. We will engage with CMS and HHS as needed on your behalf to articulate your proposal, often on the value of your product or service, and help ensure beneficiary access and appropriate reimbursement to your innovative treatments.

Need answers on Coding and Reimbursement?

Connect with our team leader:

Michael Beebe

Executive Vice President